MEDICARE: DRACARYS HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHY48314	CA
3	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1994287	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083703631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRACARYS HEALTH

Provider Business Mailing Address
First Line	:	901 W 7TH ST
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93030-6755
Country	:	US
Telephone Number	:	805-486-2688
Fax Number	:	805-487-8068

Provider Business Practice Location Address
First Line	:	901 W 7TH ST
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93030-6755
Country	:	US
Telephone Number	:	805-486-2688
Fax Number	:	805-487-8068

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JESSE MILES
Credential	:
Telephone Number	:	805-486-2688

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	08/28/2019

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Directions to “DRACARYS HEALTH ” Practice Location

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